impact of thoracic duct ligation on postoperative weight reduction in obese patients receiving minimally invasive lung surgery: a clinical investigation

Conditions: Obese Patients

Summary: this clinical trial aims to investigate whether thoracic duct ligation (tdl) can improve obesity and lipid metabolism. the primary questions it seeks to answer are: whether thoracic duct ligation can improve bmi and lipid metabolism in obese patients. the safety and feasibility of thoracic duct ligation as a treatment for obesity.

background: obesity (bmi≥28 kg/m²) is a global health crisis with limited effective interventions. emerging evidence suggests that tdl-a routine step in esophagectomy-may reduce body weight and improve lipid profiles, but its therapeutic potential for metabolic modulation remains unexplored. objectives: primary: assess safety and feasibility of tdl during video-assisted thoracoscopic surgery (vats) for stage ia1-ib lung cancer with concurrent obesity (bmi≥30 kg/m²). secondary: evaluate changes in body weight (%), lipid metabolism (ldl/hdl), inflammatory markers (crp, il-6), and fat-soluble vitamin levels. methods: single-center prospective cohort with longitudinal monitoring. eligible patients will undergo vats + tdl, with metabolic parameters measured preoperatively and at postoperative day 1/5, months 1/3/6/12. exploratory endpoints: * weight loss trajectory (% total body weight) * mechanisms of metabolic reprogramming (e.g., gut hormone shifts) * procedure-related morbidity (lymphatic leakage, vitamin deficiency) significance: first study to evaluate tdl as a potential metabolic therapy in non-esophageal surgery, providing preliminary data for future randomized trials.

Eligibility criteria:
inclusion criteria: 1. age \& gender: individuals aged 18-75 years, regardless of gender. 2. clinical profile:diagnosed with early-stage lung cancer (stage ia1-ib) and obesity (bmi ≥28 kg/m²). 3. scheduled to undergo video-assisted thoracoscopic surgery (vats) for right-sided lung cancer resection at our institution between october 2024 and october 2026. 4. surgical eligibility: approved for surgery following multidisciplinary team (mdt) assessment. 5. treatment plan: no requirement for adjuvant therapy post-lung resection. 6. preoperative evaluation:completed standard preoperative workup, including: 7. chest ct、brain ct/mri、abdominal ultrasound or pet-ct to rule out distant metastasis. 8. informed consent: willing and able to comply with study requirements, with written informed consent provided. exclusion criteria: 1. concurrent thoracic infections: patients with active intrathoracic infectious diseases (e.g., inflammatory conditions, tuberculosis). 2. refusal of novel technique: patients unwilling to undergo intraoperative thoracic duct ligation. 3. clinically unstable comorbidities: severe, unstable cardiovascular, renal, or respiratory disorders. 4. prior bariatric surgery: history of weight-loss surgery (e.g., gastric bypass, sleeve gastrectomy). 5. recent trial participation: enrollment in other clinical trials within 30 days prior to screening. 6. investigator discretion: other conditions deemed by the investigator to contraindicate participation.

Keywords: obesity therapy metabolic effects of thoracic duct ligation